Use of dexamethasone, remdesivir, convalescent plasma and prone positioning in the treatment of severe COVID-19 infection in pregnancy: A case report

A review on function and side effects of systemic corticosteroids used in high-grade COVID-19 to prevent cytokine storms

“…Also, in a controlled study with a treatment regimen consisting of inhaled corticosteroids along with remdesivir and dexamethasone, 5 out of 6 patients survived (Yatam Ganesh and Nachimuthu, 2020[ 146 ]). In a special case, a pregnant woman with COVID-19 was successfully treated with dexamethasone, remdesivir, convalescent plasma, and mechanical ventilation at 26 weeks of gestation (Jacobson et al, 2021[ 55 ]). Measurement of blood ferritin activity in patients can play an important role in determining the time window of dexamethasone administration, because the level of ferritin in patients who die is much higher than those who recover, and in fact can be a good criterion for assessing cytokine storm (Burugu et al, 2020[ 15 ]).…”

Newer modalities for treatment of severe COVID-19 infection and their use in pregnancy-boon or bane?

“…IL-6 is a central cog in the intricate network of immune response generated in the body seen with infection of COVID-19 infection. 4 COVID-19 infections create a state of systemic inflammatory response which is mediated by interleukins and cytokines. This intense response is supposed to be protective to the host but in turn is a double-edged sword which breaks down the entire immune system.…”

“…Tocilizumab has been used to treat other autoimmune diseases and data from those studies has not shown any significant increase in risk of malformations in the foetus. 4 Hepatitis and reactivation of dormant infections are the major side effects with this drug. 4 The incidence of reactivation of varicella and cytomegalovirus infection is seen to be on the rise in patients who have recovered from COVID-19.…”

“…4 Hepatitis and reactivation of dormant infections are the major side effects with this drug. 4 The incidence of reactivation of varicella and cytomegalovirus infection is seen to be on the rise in patients who have recovered from COVID-19. Tocilizumab is here to stay as a treatment modality for severe and critical COVID-19 and we have to wait and watch for its effects on pregnancy.…”

Convalescent plasma transfusion for pregnant patients with COVID-19

“…After a review of the published literature in PubMed, we found only one case of a critically ill obstetric patient with COVID-19 and 11 reports of non-critically ill obstetric patients with COVID-19 treated with convalescent plasma. 5 Some publications report encouraging results from the use of convalescent plasma in pregnant women, but others show conflicting results. We agree with the conclusions of Rodionov and colleagues, and we hypothesise that, similarly to patients with a deficient B-cellular immune response, pregnant women with no detectable anti-SARS-CoV-2 IgG are potential candidates for treatment with convalescent plasma with high antibody titres in an early stage of the disease, accompanied by a close follow-up of the antibody titre as a predictive prognostic marker.…”